For Consumers

How self-funded group health plans can protect their enrollees from surprise billing

Consumers enrolled in self-funded group health plans can get the protections of the Balance Billing Protection Act, but only if their health plan takes steps to opt-in to follow the state law. Self-funded health plans are not regulated by state laws, so the plan must first elect to follow key parts of the Balance Billing Protection Act, including:  

  • Prohibiting balance billing
  • Additional consumer protections
  • The out-of-network provider payment and dispute resolution process

Anyone enrolled in the state's public employee and school employee health benefit programs is already protected by the Balance Billing Protection Act. 

A self-funded group health plan operated by an out-of-state employer can opt-in for balance billing protections for their employees who live in Washington state and their dependents. Additionally, if a self-funded group health plan operated by a Washington state employer opts-in and has employees living in other states, the employees are protected from balance billing if they receive care from a provider in Washington state. 

How to opt-in to the Balance Billing Protection Act

A self-funded group health plan must notify the Office of the Insurance Commissioner at least 15 days in advance of when it intends to participate in and follow the Balance Billing Protection Act. If the plan is administered by a third-party administrator, that administrator also must comply with the law. 

Opt-in is for a full year. The plan can participate for any calendar or plan year and must notify us at least 15 days before the end of the year if it wants to opt-out of the law. 

See the current list of self-funded group health plans that are participating in the Balance Billing Protection Act.